Abraar Karan
BMJ Blog
Originally posted August 29, 2018
Here is an excerpt:
There are many changes that we can make to improve how we communicate about patients. One of the easiest and most critical transformations is how we write our medical notes. One of the best doctors I ever worked with did exactly this, and is famous at the Brigham (our hospital) for doing it. He systematically starts every single note with the person’s social history. Who is this patient? It is not just a lady with abdominal pain. It is a mother of three, a retired teacher, and an active cyclist. That is the first thing we read about her, and so when I enter her room, I can’t help but see her this way rather than as a case of appendicitis.
This matters because patients deserve to be treated as people—a statement that’s so obvious it shouldn’t need to be said, but which physician behaviour doesn’t always reflect. You wouldn’t expect to know the most sensitive and vulnerable aspects of someone before even knowing their most basic background, yet we do this in medicine all the time. This is also important because in many clinical presentations, it provides critical information that helps deduce how they got sick, and why they may get sick again in the same way if we don’t restructure something essential in their life. For instance, if I didn’t know that the 22 year old opioid addict had just been kicked out of his house and is on the street without transportation to get to his suboxone clinic, I will not have truly solved what brought him to the hospital in the first place.
The info is here.
Tuesday, September 18, 2018
The So-Called Right to Try Law Gives Patients False Hope
Claudia Wallis
Scientific American
Originally posted in the September 2018 issue
There's no question about it: the new law sounds just great. President Donald Trump, who knows a thing or two about marketing, gushed about its name when he signed the “Right to Try” bill into law on May 30. He was surrounded by patients with incurable diseases, including a second grader with Duchenne muscular dystrophy, who got up from his small wheelchair to hug the president. The law aims to give such patients easier access to experimental drugs by bypassing the Food and Drug Administration.
The crowd-pleasing name and concept are why 40 states had already passed similar laws, although they were largely symbolic until the federal government got onboard. The laws vary but generally say that dying patients may seek from drugmakers any medicine that has passed a phase I trial—a minimal test of safety. “We're going to be saving tremendous numbers of lives,” Trump said. “The current FDA approval process can take many, many years. For countless patients, time is not what they have.”
But the new law won't do what the president claims. Instead it gives false hope to the most vulnerable patients. “This is a right to ask, not a right to try,” says Alison Bateman-House, a medical ethicist at New York University and an expert on the compassionate use of experimental drugs.
The info is here.
Scientific American
Originally posted in the September 2018 issue
There's no question about it: the new law sounds just great. President Donald Trump, who knows a thing or two about marketing, gushed about its name when he signed the “Right to Try” bill into law on May 30. He was surrounded by patients with incurable diseases, including a second grader with Duchenne muscular dystrophy, who got up from his small wheelchair to hug the president. The law aims to give such patients easier access to experimental drugs by bypassing the Food and Drug Administration.
The crowd-pleasing name and concept are why 40 states had already passed similar laws, although they were largely symbolic until the federal government got onboard. The laws vary but generally say that dying patients may seek from drugmakers any medicine that has passed a phase I trial—a minimal test of safety. “We're going to be saving tremendous numbers of lives,” Trump said. “The current FDA approval process can take many, many years. For countless patients, time is not what they have.”
But the new law won't do what the president claims. Instead it gives false hope to the most vulnerable patients. “This is a right to ask, not a right to try,” says Alison Bateman-House, a medical ethicist at New York University and an expert on the compassionate use of experimental drugs.
The info is here.
Monday, September 17, 2018
Who Is Experiencing What Kind of Moral Distress?
Carina Fourie
AMA J Ethics. 2017;19(6):578-584.
Abstract
Moral distress, according to Andrew Jameton’s highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress—e.g., constraint and uncertainty—and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.
The info is here.
AMA J Ethics. 2017;19(6):578-584.
Abstract
Moral distress, according to Andrew Jameton’s highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress—e.g., constraint and uncertainty—and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.
The info is here.
How our lives end must no longer be a taboo subject
Kathryn Mannix
The Guardian
Originally published August 16, 2018
Here is an excerpt:
As we age and develop long-term health conditions, our chances of becoming suddenly ill rise; prospects for successful resuscitation fall; our youthful assumptions about length of life may be challenged; and our quality of life becomes increasingly more important to us than its length. The number of people over the age of 85 will double in the next 25 years, and dementia is already the biggest cause of death in this age group. What discussions do we need to have, and to repeat at sensible intervals, to ensure that our values and preferences are understood by the people who may be asked about them?
Our families need to know our answers to such questions as: how much treatment is too much or not enough? Do we see artificial hydration and nutrition as “treatment” or as basic care? Is life at any cost or quality of life more important to us? And what gives us quality of life? A 30-year-old attorney may not understand that being able to hear birdsong, or enjoy ice-cream, or follow the racing results, is more important to a family’s 85-year-old relative than being able to walk or shop. When we are approaching death, what important things should our carers know about us?
The info is here.
The Guardian
Originally published August 16, 2018
Here is an excerpt:
As we age and develop long-term health conditions, our chances of becoming suddenly ill rise; prospects for successful resuscitation fall; our youthful assumptions about length of life may be challenged; and our quality of life becomes increasingly more important to us than its length. The number of people over the age of 85 will double in the next 25 years, and dementia is already the biggest cause of death in this age group. What discussions do we need to have, and to repeat at sensible intervals, to ensure that our values and preferences are understood by the people who may be asked about them?
Our families need to know our answers to such questions as: how much treatment is too much or not enough? Do we see artificial hydration and nutrition as “treatment” or as basic care? Is life at any cost or quality of life more important to us? And what gives us quality of life? A 30-year-old attorney may not understand that being able to hear birdsong, or enjoy ice-cream, or follow the racing results, is more important to a family’s 85-year-old relative than being able to walk or shop. When we are approaching death, what important things should our carers know about us?
The info is here.
Sunday, September 16, 2018
Time to abandon grand ethical theories?
Julian Baggini
TheTLS.co
Originally posted May 22, 2018
Here are two excerpts:
Social psychologists, sociologists and anthropologists would not be baffled by this apparent contradiction. Many have long believed that morality is essentially a system of social regulation. As such it is in no more need of a divine foundation or a philosophical justification than folk dancing or tribal loyalty. Indeed, if ethics is just the management of the social sphere, it should not be surprising that as we live in a more globalized world, ethics becomes enlarged to encompass not only how we treat kith and kin but our distant neighbours too.
Philosophers have more to worry about. They are not generally satisfied to see morality as a purely pragmatic means of keeping the peace. To see the world muddling through morality is deeply troubling. Where’s the consistency? Where’s the theoretical framework? Where’s the argument?
(cut)
There is then a curious combination of incoherence and vagueness about just what it is to be ethical, and a bogus precision in the ways in which organizations prove themselves to be good. All this confusion helps fuel philosophical ethics, which has become a vibrant, thriving discipline, providing academic presses with a steady stream of books. Looking over a sample of their recent output, it is evident that moral philosophers are keen to show that they are not just playing intellectual games and that they have something to offer the world.
The info is here.
TheTLS.co
Originally posted May 22, 2018
Here are two excerpts:
Social psychologists, sociologists and anthropologists would not be baffled by this apparent contradiction. Many have long believed that morality is essentially a system of social regulation. As such it is in no more need of a divine foundation or a philosophical justification than folk dancing or tribal loyalty. Indeed, if ethics is just the management of the social sphere, it should not be surprising that as we live in a more globalized world, ethics becomes enlarged to encompass not only how we treat kith and kin but our distant neighbours too.
Philosophers have more to worry about. They are not generally satisfied to see morality as a purely pragmatic means of keeping the peace. To see the world muddling through morality is deeply troubling. Where’s the consistency? Where’s the theoretical framework? Where’s the argument?
(cut)
There is then a curious combination of incoherence and vagueness about just what it is to be ethical, and a bogus precision in the ways in which organizations prove themselves to be good. All this confusion helps fuel philosophical ethics, which has become a vibrant, thriving discipline, providing academic presses with a steady stream of books. Looking over a sample of their recent output, it is evident that moral philosophers are keen to show that they are not just playing intellectual games and that they have something to offer the world.
The info is here.
Saturday, September 15, 2018
Social Science One And How Top Journals View The Ethics Of Facebook Data Research
Kalev Leetaru
Forbes.com
Originally posted on August 13, 2018
Here is an excerpt:
At the same time, Social Science One’s decision to leave all ethical questions TBD and to eliminate the right to informed consent or the ability to opt out of research fundamentally redefines what it means to conduct research in the digital era, normalizing the removal of these once sacred ethical tenets. Given the refusal of one of its committee members to provide replication data for his own study and the statement by another committee member that “I have articulated the argument that ToS are not, and should not be considered, ironclad rules binding the activities of academic researchers. … I don't think researchers should reasonably be expected to adhere to such conditions, especially at a time when officially sanctioned options for collecting social media data are disappearing left and right,” the result is an ethically murky landscape in which it is unclear just where Social Science One draws the line at what it will or will not permit.
Given Facebook’s new focus on “privacy first” I asked the company whether it would commit to offering its two billion users a new profile setting allowing them to opt out of having their data made available to academic researchers such as Social Science One. As it has repeatedly done in the past, the company declined to comment.
The info is here.
Forbes.com
Originally posted on August 13, 2018
Here is an excerpt:
At the same time, Social Science One’s decision to leave all ethical questions TBD and to eliminate the right to informed consent or the ability to opt out of research fundamentally redefines what it means to conduct research in the digital era, normalizing the removal of these once sacred ethical tenets. Given the refusal of one of its committee members to provide replication data for his own study and the statement by another committee member that “I have articulated the argument that ToS are not, and should not be considered, ironclad rules binding the activities of academic researchers. … I don't think researchers should reasonably be expected to adhere to such conditions, especially at a time when officially sanctioned options for collecting social media data are disappearing left and right,” the result is an ethically murky landscape in which it is unclear just where Social Science One draws the line at what it will or will not permit.
Given Facebook’s new focus on “privacy first” I asked the company whether it would commit to offering its two billion users a new profile setting allowing them to opt out of having their data made available to academic researchers such as Social Science One. As it has repeatedly done in the past, the company declined to comment.
The info is here.
Friday, September 14, 2018
Law, Ethics, and Conversations between Physicians and Patients about Firearms in the Home
Alexander D. McCourt, and Jon S. Vernick
AMA J Ethics. 2018;20(1):69-76.
Abstract
Firearms in the home pose a risk to household members, including homicide, suicide, and unintentional deaths. Medical societies urge clinicians to counsel patients about those risks as part of sound medical practice. Depending on the circumstances, clinicians might recommend safe firearm storage, temporary removal of the firearm from the home, or other measures. Certain state firearm laws, however, might present legal and ethical challenges for physicians who counsel patients about guns in the home. Specifically, we discuss state background check laws for gun transfers, safe gun storage laws, and laws forbidding physicians from engaging in certain firearm-related conversations with their patients. Medical professionals should be aware of these and other state gun laws but should offer anticipatory guidance when clinically appropriate.
The info is here.
AMA J Ethics. 2018;20(1):69-76.
Abstract
Firearms in the home pose a risk to household members, including homicide, suicide, and unintentional deaths. Medical societies urge clinicians to counsel patients about those risks as part of sound medical practice. Depending on the circumstances, clinicians might recommend safe firearm storage, temporary removal of the firearm from the home, or other measures. Certain state firearm laws, however, might present legal and ethical challenges for physicians who counsel patients about guns in the home. Specifically, we discuss state background check laws for gun transfers, safe gun storage laws, and laws forbidding physicians from engaging in certain firearm-related conversations with their patients. Medical professionals should be aware of these and other state gun laws but should offer anticipatory guidance when clinically appropriate.
The info is here.
What Are “Ethics in Design”?
Victoria Sgarro
slate.com
Originally posted August 13, 2018
Here is an excerpt:
As a product designer, I know that no mandate exists to integrate these ethical checks and balances in our process. While I may hear a lot of these issues raised at speaking events and industry meetups, more “practical” considerations can overshadow these conversations in my day-to-day decision making. When they have to compete with the workaday pressures of budgets, roadmaps, and clients, these questions won’t emerge as priorities organically.
Most important, then, is action. Castillo worries that the conversation about “ethics in design” could become a cliché, like “empathy” or “diversity” in tech, where it’s more talk than walk. She says it’s not surprising that ethics in tech hasn’t been addressed in depth in the past, given the industry’s lack of diversity. Because most tech employees come from socially privileged backgrounds, they may not be as attuned to ethical concerns. A designer who identifies with society’s dominant culture may have less personal need to take another perspective. Indeed, identification with a society’s majority is shown to be correlated with less critical awareness of the world outside of yourself. Castillo says that, as a black woman in America, she’s a bit wary of this conversation’s effectiveness if it remains only a conversation.
“You know how someone says, ‘Why’d you become a nurse or doctor?’ And they say, ‘I want to help people’?” asks Castillo. “Wouldn’t it be cool if someone says, ‘Why’d you become an engineer or a product designer?’ And you say, ‘I want to help people.’ ”
The info is here.
slate.com
Originally posted August 13, 2018
Here is an excerpt:
As a product designer, I know that no mandate exists to integrate these ethical checks and balances in our process. While I may hear a lot of these issues raised at speaking events and industry meetups, more “practical” considerations can overshadow these conversations in my day-to-day decision making. When they have to compete with the workaday pressures of budgets, roadmaps, and clients, these questions won’t emerge as priorities organically.
Most important, then, is action. Castillo worries that the conversation about “ethics in design” could become a cliché, like “empathy” or “diversity” in tech, where it’s more talk than walk. She says it’s not surprising that ethics in tech hasn’t been addressed in depth in the past, given the industry’s lack of diversity. Because most tech employees come from socially privileged backgrounds, they may not be as attuned to ethical concerns. A designer who identifies with society’s dominant culture may have less personal need to take another perspective. Indeed, identification with a society’s majority is shown to be correlated with less critical awareness of the world outside of yourself. Castillo says that, as a black woman in America, she’s a bit wary of this conversation’s effectiveness if it remains only a conversation.
“You know how someone says, ‘Why’d you become a nurse or doctor?’ And they say, ‘I want to help people’?” asks Castillo. “Wouldn’t it be cool if someone says, ‘Why’d you become an engineer or a product designer?’ And you say, ‘I want to help people.’ ”
The info is here.
Thursday, September 13, 2018
How Should Clinicians Respond to Requests from Patients to Participate in Prayer?
A. R. Christensen, T. E. Cook, and R. M. ArnoldAMA J Ethics. 2018;20(7):E621-629.
Abstract
Over the past 20 years, physicians have shifted from viewing a patient’s request for prayer as a violation of professional boundaries to a question deserving nuanced understanding of the patient’s needs and the clinician’s boundaries. In this case, Mrs. C’s request for prayer can reflect religious distress, anxiety about her clinical circumstances, or a desire to better connect with her physician. These different needs suggest that it is important to understand the request before responding. To do this well requires that Dr. Q not be emotionally overwhelmed by the request and that she has skill in discerning potential reasons for the request.
The info is here.
Subscribe to:
Posts (Atom)